Missoi Tara G, Lueder Gregg T, Gilbertson Kenneth, Bayliss Susan J
Department of Ophthalmology, University of Missouri-Columbia, Columbia, MO 65212, USA.
Arch Ophthalmol. 2011 Jul;129(7):899-903. doi: 10.1001/archophthalmol.2011.40. Epub 2011 Mar 14.
To evaluate the efficacy and adverse effects of oral propranolol for treatment of periocular infantile hemangioma.
Participants were treated with oral propranolol 3 times daily, with outpatient monitoring of adverse effects. The starting dosage was 0.5 mg/kg/d for 1 week, then 1 mg/kg/d for the following week, then 2 mg/kg/d for the remaining duration of treatment. Serial examinations and external photography documented the size of the hemangiomas. Complete ophthalmic examinations included assessing for amblyopia with cycloplegic refraction and visual diagnostic testing. Amblyopia was treated with part-time occlusion therapy.
Nineteen periocular hemangiomas from 17 children (71% girls) were studied. The median age at the start of treatment was 4.5 months (interquartile range, 2.2-5.6 months). The median treatment duration was 6.8 months (interquartile range, 4.1-7.2 months). Treatment with oral propranolol reduced the size of all hemangiomas. Median change in the surface area was 61% (interquartile range, 32%-64%) of the original size. Mild rebound growth that did not necessitate retreatment was found in 2 patients (12%). One patient (6%) experienced a benign episode of bradycardia. Seven patients (41%) had amblyopia.
Oral propranolol for treatment of infantile hemangiomas was effective in all patients, with 33% reduction in astigmatism and 39% reduction in surface area. Vision equalized in all but 1 child, who receives ongoing amblyopia therapy. Our results suggest that early treatment with propranolol is remarkably effective in treating and preventing loss of visual acuity associated with periocular infantile hemangiomas.
评估口服普萘洛尔治疗眼周婴幼儿血管瘤的疗效及不良反应。
参与者每日口服普萘洛尔3次，并在门诊监测不良反应。起始剂量为0.5mg/kg/d，持续1周，随后1mg/kg/d，持续接下来的1周，之后在剩余治疗期间为2mg/kg/d。系列检查及外部拍照记录血管瘤大小。完整的眼科检查包括用睫状肌麻痹验光和视觉诊断测试评估弱视情况。弱视采用部分时间遮盖疗法治疗。
研究了17名儿童的19个眼周血管瘤（71%为女孩）。治疗开始时的中位年龄为4.5个月（四分位间距，2.2 - 5.6个月）。中位治疗持续时间为6.8个月（四分位间距，4.1 - 7.2个月）。口服普萘洛尔治疗使所有血管瘤体积缩小。表面积的中位变化为原始大小的61%（四分位间距，32% - 64%）。2名患者（12%）出现轻度反弹生长，但无需再次治疗。1名患者（6%）经历了一次良性心动过缓发作。7名患者（41%）有弱视。
口服普萘洛尔治疗婴幼儿血管瘤对所有患者均有效，散光减少33%，表面积减少39%。除1名正在接受弱视治疗的儿童外，所有儿童视力均恢复正常。我们的结果表明，早期使用普萘洛尔治疗对于治疗和预防与眼周婴幼儿血管瘤相关的视力丧失非常有效。
